In recent years, the globalization of the food supply and the development of extensive food distr... more In recent years, the globalization of the food supply and the development of extensive food distribution networks have increased the risk of foodborne disease outbreaks involving multiple states or countries. In particular, outbreaks associated with fresh produce have emerged as an important public health concern. During July and August 1998, eight restaurant-associated outbreaks of shigellosis caused by a common strain of Shigella sonnei occurred in the United States and Canada. The outbreak strain was characterized by unique pulsed-field gel electrophoresis patterns. Epidemiologic investigation determined that the illness was associated with the ingestion of parsley at four restaurants; at the other four restaurants, the majority of the people who contracted the illness ate parsley. Isolates from patrons in two unrelated restaurant-associated enterotoxigenic Escherichia coli (ETEC) outbreaks in Minnesota shared a common serotype and pulsed-field gel electrophoresis (PFGE) pattern....
Background Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data ... more Background Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data are limited. We conducted laboratory-based diarrhea surveillance in Guatemala. Methods A diarrhea case was defined as ≥3 loose stools in a 24-h period in a person presenting to the surveillance facilities. Epidemiologic data and stool specimens were collected. Specimens were tested for bacterial, parasitic, and viral pathogens. Yearly incidence was adjusted for healthcare seeking behaviors determined from a household survey conducted in the surveillance catchment area. Results From November 2008 to December 2012, the surveillance system captured 5331 diarrhea cases; among these 1381 (26%) had specimens tested for all enteric pathogens of interest. The adjusted incidence averaged 659 diarrhea cases per 10,000 persons per year, and was highest among children aged < 5 years, averaging 1584 cases per 10,000 children per year. Among 1381 (26%) specimens tested for all the pathogens of inte...
SUMMARYCameroon has experienced recurrent cholera epidemics with high mortality rates. In Septemb... more SUMMARYCameroon has experienced recurrent cholera epidemics with high mortality rates. In September 2009, epidemic cholera was detected in the Far North region of Cameroon and the reported case-fatality rate was 12%. We conducted village-, healthcare facility- and community-level surveys to investigate reasons for excess cholera mortality. Results of this investigation suggest that cholera patients who died were less likely to seek care, receive rehydration therapy and antibiotics at a healthcare facility, and tended to live further from healthcare facilities. Furthermore, use of oral rehydration salts at home was very low in both decedents and survivors. Despite the many challenges inherent to delivering care in Cameroon, practical measures could be taken to reduce cholera mortality in this region, including the timely provision of treatment supplies, training of healthcare workers, establishment of rehydration centres, and promotion of household water treatment and enhanced handwa...
The American journal of tropical medicine and hygiene, Jan 20, 2015
During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; n... more During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; no cholera outbreaks have been reported in Ugandan health facilities. In October 2008, a unique cholera outbreak was confirmed in Butabika National Mental Referral Hospital (BNMRH), Uganda. This article describes actions taken to control the outbreak, challenges, and lessons learnt. We reviewed patient and hospital reports for clinical symptoms and signs, treatment and outcome, patient mental diagnosis, and challenges noted during management of patients and contacts. Out of 114 BNMRH patients on two affected wards, 18 cholera cases and five deaths were documented for an attack rate of 15.8% and a case fatality rate of 28%. Wards and surroundings were intensively disinfected and 96 contacts (psychiatric patients) in the affected wards received chemoprophylaxis with oral ciprofloxacin 500 mg twice daily until November 5, 2008. We documented a nosocomial cholera outbreak in BNMRH with a high...
Abstract. Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe ... more Abstract. Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe since 2010. During October 1, 2011–April 30, 2012, 4,181 suspected and 52 confirmed cases of typhoid fever were identified in Harare. In response to this outbreak, chlorine tablets were distributed. To evaluate household water treatment uptake, we conducted a survey and water quality testing in 458 randomly selected households in two suburbs most affected by the outbreak. Although 75 % of households were aware of chlorine solution and 85 % received chlorine tablets, only 18 % had
Abstract. Street-vended foods and beverages, an integral part of urban economies in the developin... more Abstract. Street-vended foods and beverages, an integral part of urban economies in the developing world, have been implicated in cholera transmission in Latin America. To improve the microbiologic quality of market-vended beverages in Guatemala, we tested a simple system consisting of dilute bleach (4.95 % free available chlorine) for water purification, narrow-mouth plastic vessels with spigots for disinfecting and storing water and for preparing and storing beverages, handwashing soap, and education in using the system. We conducted a randomized controlled intervention trial among 41 vendors who received the intervention and 42 control vendors, comparing total and fecal coliform bacteria and Escherichia coli contamination of market-vended beverages, stored water, and vendors ’ hands. Samples were obtained at baseline and at each of six weekly follow-up visits. At baseline, fecal coliform bacteria were found in 40 (48%) market-vended beverages and E. coli in 14 (17%). When compare...
Typhoid vaccination is recommended in the United States before travel to countries where typhoid ... more Typhoid vaccination is recommended in the United States before travel to countries where typhoid fever is endemic, though little information is available on its effectiveness in travelers. We estimated typhoid vaccination effectiveness (VE) by comparing vaccination status in cases of typhoid fever and paratyphoid fever (Salmonella Paratyphi A infection, against which typhoid vaccine offers no protection) reported in the United States. We included travelers to Southern Asia and excluded persons <2 years old and cases in which vaccination status was not reported. From 2008 through 2011, 744 eligible cases (602 typhoid, 142 paratyphoid A) were reported to CDC. accination effectiveness nited States ravelers Typhoid vaccination was reported for 5% (29/602) of typhoid patients and for 20% (29/142) of paratyphoid A patients. Estimated VE was 80% (95% confidence interval, 66–89%). Because of missing data, we could not estimate VE for specific vaccines. We demonstrated moderate effectiven...
On May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of ... more On May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of children presenting to the emergency department with bloody diarrhea. Based on preliminary testing of stool specimens, Entamoeba histolytica infection was suspected as a possible cause. Shigella was also suspected in a subset of samples. On May 22, the American Samoa Department of Health requested assistance from CDC with the outbreak investigation. The goals of the investigation were to establish the presence of an outbreak, characterize its epidemiology and etiology, and recommend control measures. The CDC field team reviewed the emergency department log book for cases of diarrheal illness during April 15-June 13, 2014. During this period, 280 cases of diarrheal illness were recorded, with a peak occurring on May 10. Twice as many cases occurred during this period in 2014 compared with the same period in 2011, the most recent year for which comparable surveillance data were available. ...
Ceftriaxone-resistant Salmonella enterica serotype Typhi (Typhi), the bacterium that causes typho... more Ceftriaxone-resistant Salmonella enterica serotype Typhi (Typhi), the bacterium that causes typhoid fever, is a growing public health threat. Extensively drug-resistant (XDR) Typhi is resistant to ceftriaxone and other antibiotics used for treatment, including ampicillin, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole (1). In March 2018, CDC began enhanced surveillance for ceftriaxone-resistant Typhi in response to an ongoing outbreak of XDR typhoid fever in Pakistan. CDC had previously reported the first five cases of XDR Typhi in the United States among patients who had spent time in Pakistan (2). These illnesses represented the first cases of ceftriaxone-resistant Typhi documented in the United States (3). This report provides an update on U.S. cases of XDR typhoid fever linked to Pakistan and describes a new, unrelated cluster of ceftriaxone-resistant Typhi infections linked to Iraq. Travelers to areas with endemic Typhi should receive typhoid vaccination before traveling and adhere to safe food and water precautions (4). Treatment of patients with typhoid fever should be guided by antimicrobial susceptibility testing whenever possible (5), and clinicians should consider travel history when selecting empiric therapy.
In 1854, John Snow’s work on cholera in London immortalised the power of mapping as a tool for di... more In 1854, John Snow’s work on cholera in London immortalised the power of mapping as a tool for disease prevention and control. Over 160 years later, a more ambitious effort to map cholera has been reported in The Lancet. Forgoing so-called shoe leather epidemiology in favour of big data, Justin Lessler and colleagues used 279 cholera datasets covering 2283 locations in 37 countries, and cluster-level maps of access to improved water and sanitation in 41 countries, to map cholera incidence across sub-Saharan Africa at a 20 km × 20 km grid scale. They merged this incidence grid with census data and subnational administrative borders to identify and rank districts by their mean annual cholera incidence. Based on these analyses, they estimate that 151 of 3751 districts (4·0%, 95% credible interval [CrI] 1·7 to 16·8) in sub-Saharan Africa, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), can be classified as high incidence (>1 case per 1000 people), and that targeting just 35·3 million people (95% CrI 26·3 million to 62·0 million) in the highest incidence districts with proven interventions—safe water, sanitation, and cholera vaccination—could reduce mean annual cholera incidence in the entire region by 50%. Alternatively, targeting 50·8 million people (95% CrI 39·7 million to 62·8 million) in just five countries (Somalia, Nigeria, Democratic Republic of the Congo, Sierra Leone, and Ghana) could prevent over 38% of all regional cholera cases. These encouraging results provide a region-wide geospatial roadmap to guide the actions described in WHO and partners’ Ending Cholera: a Global Roadmap to 2030, released by the Global Task Force on Cholera Control in 2017. Lessler and colleagues show that highburden cholera hot spots to target with interventions can be identified in each affected country. Furthermore, some issues might still need attention, the study by Pylypchuk and colleagues sets an example to other investigators in this field.
In recent years, the globalization of the food supply and the development of extensive food distr... more In recent years, the globalization of the food supply and the development of extensive food distribution networks have increased the risk of foodborne disease outbreaks involving multiple states or countries. In particular, outbreaks associated with fresh produce have emerged as an important public health concern. During July and August 1998, eight restaurant-associated outbreaks of shigellosis caused by a common strain of Shigella sonnei occurred in the United States and Canada. The outbreak strain was characterized by unique pulsed-field gel electrophoresis patterns. Epidemiologic investigation determined that the illness was associated with the ingestion of parsley at four restaurants; at the other four restaurants, the majority of the people who contracted the illness ate parsley. Isolates from patrons in two unrelated restaurant-associated enterotoxigenic Escherichia coli (ETEC) outbreaks in Minnesota shared a common serotype and pulsed-field gel electrophoresis (PFGE) pattern....
Background Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data ... more Background Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data are limited. We conducted laboratory-based diarrhea surveillance in Guatemala. Methods A diarrhea case was defined as ≥3 loose stools in a 24-h period in a person presenting to the surveillance facilities. Epidemiologic data and stool specimens were collected. Specimens were tested for bacterial, parasitic, and viral pathogens. Yearly incidence was adjusted for healthcare seeking behaviors determined from a household survey conducted in the surveillance catchment area. Results From November 2008 to December 2012, the surveillance system captured 5331 diarrhea cases; among these 1381 (26%) had specimens tested for all enteric pathogens of interest. The adjusted incidence averaged 659 diarrhea cases per 10,000 persons per year, and was highest among children aged < 5 years, averaging 1584 cases per 10,000 children per year. Among 1381 (26%) specimens tested for all the pathogens of inte...
SUMMARYCameroon has experienced recurrent cholera epidemics with high mortality rates. In Septemb... more SUMMARYCameroon has experienced recurrent cholera epidemics with high mortality rates. In September 2009, epidemic cholera was detected in the Far North region of Cameroon and the reported case-fatality rate was 12%. We conducted village-, healthcare facility- and community-level surveys to investigate reasons for excess cholera mortality. Results of this investigation suggest that cholera patients who died were less likely to seek care, receive rehydration therapy and antibiotics at a healthcare facility, and tended to live further from healthcare facilities. Furthermore, use of oral rehydration salts at home was very low in both decedents and survivors. Despite the many challenges inherent to delivering care in Cameroon, practical measures could be taken to reduce cholera mortality in this region, including the timely provision of treatment supplies, training of healthcare workers, establishment of rehydration centres, and promotion of household water treatment and enhanced handwa...
The American journal of tropical medicine and hygiene, Jan 20, 2015
During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; n... more During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; no cholera outbreaks have been reported in Ugandan health facilities. In October 2008, a unique cholera outbreak was confirmed in Butabika National Mental Referral Hospital (BNMRH), Uganda. This article describes actions taken to control the outbreak, challenges, and lessons learnt. We reviewed patient and hospital reports for clinical symptoms and signs, treatment and outcome, patient mental diagnosis, and challenges noted during management of patients and contacts. Out of 114 BNMRH patients on two affected wards, 18 cholera cases and five deaths were documented for an attack rate of 15.8% and a case fatality rate of 28%. Wards and surroundings were intensively disinfected and 96 contacts (psychiatric patients) in the affected wards received chemoprophylaxis with oral ciprofloxacin 500 mg twice daily until November 5, 2008. We documented a nosocomial cholera outbreak in BNMRH with a high...
Abstract. Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe ... more Abstract. Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe since 2010. During October 1, 2011–April 30, 2012, 4,181 suspected and 52 confirmed cases of typhoid fever were identified in Harare. In response to this outbreak, chlorine tablets were distributed. To evaluate household water treatment uptake, we conducted a survey and water quality testing in 458 randomly selected households in two suburbs most affected by the outbreak. Although 75 % of households were aware of chlorine solution and 85 % received chlorine tablets, only 18 % had
Abstract. Street-vended foods and beverages, an integral part of urban economies in the developin... more Abstract. Street-vended foods and beverages, an integral part of urban economies in the developing world, have been implicated in cholera transmission in Latin America. To improve the microbiologic quality of market-vended beverages in Guatemala, we tested a simple system consisting of dilute bleach (4.95 % free available chlorine) for water purification, narrow-mouth plastic vessels with spigots for disinfecting and storing water and for preparing and storing beverages, handwashing soap, and education in using the system. We conducted a randomized controlled intervention trial among 41 vendors who received the intervention and 42 control vendors, comparing total and fecal coliform bacteria and Escherichia coli contamination of market-vended beverages, stored water, and vendors ’ hands. Samples were obtained at baseline and at each of six weekly follow-up visits. At baseline, fecal coliform bacteria were found in 40 (48%) market-vended beverages and E. coli in 14 (17%). When compare...
Typhoid vaccination is recommended in the United States before travel to countries where typhoid ... more Typhoid vaccination is recommended in the United States before travel to countries where typhoid fever is endemic, though little information is available on its effectiveness in travelers. We estimated typhoid vaccination effectiveness (VE) by comparing vaccination status in cases of typhoid fever and paratyphoid fever (Salmonella Paratyphi A infection, against which typhoid vaccine offers no protection) reported in the United States. We included travelers to Southern Asia and excluded persons <2 years old and cases in which vaccination status was not reported. From 2008 through 2011, 744 eligible cases (602 typhoid, 142 paratyphoid A) were reported to CDC. accination effectiveness nited States ravelers Typhoid vaccination was reported for 5% (29/602) of typhoid patients and for 20% (29/142) of paratyphoid A patients. Estimated VE was 80% (95% confidence interval, 66–89%). Because of missing data, we could not estimate VE for specific vaccines. We demonstrated moderate effectiven...
On May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of ... more On May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of children presenting to the emergency department with bloody diarrhea. Based on preliminary testing of stool specimens, Entamoeba histolytica infection was suspected as a possible cause. Shigella was also suspected in a subset of samples. On May 22, the American Samoa Department of Health requested assistance from CDC with the outbreak investigation. The goals of the investigation were to establish the presence of an outbreak, characterize its epidemiology and etiology, and recommend control measures. The CDC field team reviewed the emergency department log book for cases of diarrheal illness during April 15-June 13, 2014. During this period, 280 cases of diarrheal illness were recorded, with a peak occurring on May 10. Twice as many cases occurred during this period in 2014 compared with the same period in 2011, the most recent year for which comparable surveillance data were available. ...
Ceftriaxone-resistant Salmonella enterica serotype Typhi (Typhi), the bacterium that causes typho... more Ceftriaxone-resistant Salmonella enterica serotype Typhi (Typhi), the bacterium that causes typhoid fever, is a growing public health threat. Extensively drug-resistant (XDR) Typhi is resistant to ceftriaxone and other antibiotics used for treatment, including ampicillin, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole (1). In March 2018, CDC began enhanced surveillance for ceftriaxone-resistant Typhi in response to an ongoing outbreak of XDR typhoid fever in Pakistan. CDC had previously reported the first five cases of XDR Typhi in the United States among patients who had spent time in Pakistan (2). These illnesses represented the first cases of ceftriaxone-resistant Typhi documented in the United States (3). This report provides an update on U.S. cases of XDR typhoid fever linked to Pakistan and describes a new, unrelated cluster of ceftriaxone-resistant Typhi infections linked to Iraq. Travelers to areas with endemic Typhi should receive typhoid vaccination before traveling and adhere to safe food and water precautions (4). Treatment of patients with typhoid fever should be guided by antimicrobial susceptibility testing whenever possible (5), and clinicians should consider travel history when selecting empiric therapy.
In 1854, John Snow’s work on cholera in London immortalised the power of mapping as a tool for di... more In 1854, John Snow’s work on cholera in London immortalised the power of mapping as a tool for disease prevention and control. Over 160 years later, a more ambitious effort to map cholera has been reported in The Lancet. Forgoing so-called shoe leather epidemiology in favour of big data, Justin Lessler and colleagues used 279 cholera datasets covering 2283 locations in 37 countries, and cluster-level maps of access to improved water and sanitation in 41 countries, to map cholera incidence across sub-Saharan Africa at a 20 km × 20 km grid scale. They merged this incidence grid with census data and subnational administrative borders to identify and rank districts by their mean annual cholera incidence. Based on these analyses, they estimate that 151 of 3751 districts (4·0%, 95% credible interval [CrI] 1·7 to 16·8) in sub-Saharan Africa, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), can be classified as high incidence (>1 case per 1000 people), and that targeting just 35·3 million people (95% CrI 26·3 million to 62·0 million) in the highest incidence districts with proven interventions—safe water, sanitation, and cholera vaccination—could reduce mean annual cholera incidence in the entire region by 50%. Alternatively, targeting 50·8 million people (95% CrI 39·7 million to 62·8 million) in just five countries (Somalia, Nigeria, Democratic Republic of the Congo, Sierra Leone, and Ghana) could prevent over 38% of all regional cholera cases. These encouraging results provide a region-wide geospatial roadmap to guide the actions described in WHO and partners’ Ending Cholera: a Global Roadmap to 2030, released by the Global Task Force on Cholera Control in 2017. Lessler and colleagues show that highburden cholera hot spots to target with interventions can be identified in each affected country. Furthermore, some issues might still need attention, the study by Pylypchuk and colleagues sets an example to other investigators in this field.
Uploads
Papers by Eric Mintz